Living with HIV: Maluba’s story

There are over 103,000 people in the UK living with HIV, and over 600 people died from HIV/AIDS in 2014. Here is one woman’s story about life with the virus

Maluba lives in Bristol with her four-year-old son. She is unemployed, a “luke-warm Christian”, speaks loudly and laughs a lot. She was raised in Zambia, but after living in Britain on and off since 1991, she finally settled here in 2006 – 11 years after diagnosis. She contracted HIV (human immunodeficiency virus) in Britain, but was diagnosed in her country of birth. Being diagnosed in Zambia was a godsend, she says.

“If I’d got tested here I probably would have died – the stigma would have killed me,” she says. “When I was in Zambia it wasn’t an issue – everyone is either infected or affected. But when I came here, the so-called First World, I realised how ignorant Brits were about HIV.”

How HIV is transmitted

HIV is a retrovirus, which means it contains RNA rather than DNA as its genetic material.

It is spread through certain body fluids, including blood, semen and breast milk. HIV can be transmitted through activities including unprotected sex, sharing infected needles (in a medical setting or when using intravenous drugs) and receiving infected blood transfusions. An HIV-positive mother can transmit the virus to her baby during birth or breastfeeding.

What HIV does in the cell

Once in the blood, HIV particles bind to CD4 receptors on the surface of a type of white blood cell called a helper T cell (also known as a CD4+ cell). The virus binds with the cell, releasing viral RNA and enzymes into the cell’s cytoplasm.

Reverse transcriptase is one of the viral enzymes inserted into the cell. It converts the single-stranded viral RNA to double-stranded DNA. This DNA is integrated into the genome of the helper T cell. This means that the helper T cell is now effectively an HIV-replicating cell.

The cell now produces viral RNAs. One type of RNA is transported to the Golgi apparatus in the cell, where it is used to produce viral proteins. The other type is a copy of the RNA found in HIV. An enzyme called a protease helps the proteins fold into their functional shapes.

The proteins and RNA combine and new virus particles (virions) bud off from the helper T cell. The host cell is destroyed by this process. Over time, HIV depletes the CD4+ cells in the body, leaving the person’s immune system unable to respond adequately to infections.

Treating HIV

Reverse transcriptase does not have the ‘proofreading’ ability of DNA polymerase, the enzyme that copies a single DNA strand during DNA replication. The copying of RNA is therefore more prone to errors, which means that HIV can mutate faster than, say, a DNA virus such as lambda phage.

People with the virus are advised to take a combination of drugs from at least two of the five HIV drug classes. Using a combination (something known as highly active antiretroviral therapy, or HAART) helps fight drug-resistant versions of HIV that are created when the HIV particles copy themselves.

The types of HIV drugs include reverse transcriptase inhibitors and protease inhibitors, both of which block the action of enzymes essential to the replication of HIV.

Health impacts of HIV

Signs of HIV include flu-like symptoms several weeks after infection. HIV can then remain symptomless for a period of time. When helper T cell levels become low, the person becomes vulnerable to so-called opportunistic infections and related conditions, including thrush, tuberculosis (TB), pneumonia and a rare cancer called Kaposi’s sarcoma.

Between 2004 and 2006 Maluba lost her sense of smell and taste, a commonly reported side-effect of some HIV medication.

“I have high blood pressure; I also have fibromyalgia,” she says, referring to the chronic pain condition, the causes of which are unknown.

“I’ve had neuropathy [a nerve disorder] since 2002. And lipodystrophy [redistribution of fat around the body, caused by an early medication] – it’s something I can’t come to terms with because it’s physical, obvious. A giveaway. I’ve lost fat from my bottom and it’s all gone up, to my tummy, my back, my upper arms. It’s disgusting. It affects what I wear; it affects my confidence. There’s nothing I can do about it.”

Having a child

Becoming pregnant in 2009 wasn’t an issue for Maluba. HIV positive since 1995 and on medication since 2002, she knew that with an undetectable viral load (the amount of virus in the blood) there was almost no chance of passing HIV on to her baby.

“It was a question of when I get pregnant, not if,” she says, adding that her son will “just grow up knowing” about her status. But many women do not have so much time to come to terms with their diagnosis before pregnancy.

Thanks to the now routine HIV screening in antenatal clinics, many discover they are pregnant and HIV positive at the same time. This raises many issues – including the future health of the unborn baby, the mother’s health, whether she has other children that need to be tested, and how to tell her partner.

As HIV medication can interact with the contraceptive pill, a diagnosis can make it harder for some women to prevent future unwanted pregnancies. Maluba, due to such interactions, has never felt she could use the pill, and so relies solely on condoms. As it is, she has enough medical issues to deal with day to day.

Questions for discussion

Research and write down two groups of people who are particularly at risk of becoming infected with HIV in the UK.

What kind of things might stop someone from seeking medical help if they think they might be at risk of contracting HIV? Think about practical, cultural and social factors.

HIV is a retrovirus. What does the term retrovirus mean?

Why might a retrovirus mutate faster than a DNA virus?

How might a high rate of virus mutation affect resistance to drugs used to treat HIV?

Françoise Barré-Sinoussi won the Nobel Prize for identifying HIV as the cause of AIDS. Do some research and find another woman who has won the Nobel Prize for research with a medical application (relevant Nobel Prize categories include ‘Chemistry’ and ‘Physiology or Medicine’). Write a short article outlining her life and the work that led to her winning the prize.

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